Local fluid dynamics in patients with bifurcated coronary lesions undergoing percutaneous coronary interventions

Figure 1. An idealized coronary artery bifurcation. The bifurcation anatomy is usually best described by the three segments model comprised of the proximal main vessel (MV), the distal MV and side branch (SB). The area comprised of the ideal interception between MV and SB is commonly identified as the polygon of confluence.

Figure 2. Theoretical local shear stress (SS) distribution in an idealized coronary artery bifurcation before and after stent implantation; A. Before stenting (low SS values are present at the level of lateral walls of the main vessel (MV) and the proximal side branch (SB), while high SS values are at the level of the carina and at the internal walls of the distal MV and SB); B. After stent implantation in the MV without intervention on the SB; C. After MV stenting followed by kissing balloon inflation with short balloons selected in order to avoid proximal MV overstretch; D. After the double stenting technique.

Figure 3. Local shear stress distribution around the stent struts and their possible interactions with circulating platelets. Regions of low shear stress are localized around stent struts and are associated with stagnation flow and boundary layer separation immediately upstream and downstream of the struts.